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FIGURE 5. Algorithm demonstrating the differential diagnosis of itching and dryness in young females. The picture highlights the clinical characteristics of itchy-dry eye associated (IDEA) syndrome, summarizing the differential diagnostic criteria among IDEA, allergic conjunctivitis, aqueous tear deficient dry eye, and evaporative dry eye. History, clinical features, systemic diseases, and diagnostic markers may help to achieve the correct diagnosis. Patients with polycystic ovary syndrome (PCOS) may have clinical signs and symptoms that overlap other ocular surface diseases. However, IDEA is a distinct clinical entity characterized by a peculiar personal history (polycystic ovary), typical gender and age, and typical clinical and biochemical systemic markers with a peculiar association of common ocular signs and symptoms. BUT = breakup time.

http://www.merckmanuals.com/professional/eye_disorders/symptoms_of_ophthalmologic_disorders/ acute_vision_loss.html

Acute Vision Loss


Acute Vision Loss: A Merck Manual of Patient Symptoms podcast

Loss of vision is usually considered acute if it develops within a few minutes to a couple of days. It may affect one or both eyes and all or part of a visual field. Patients with small visual field defects (eg, caused by a small retinal detachment) may describe their symptoms as blurred vision.

Pathophysiology
Acute loss of vision has 3 general causes:

Opacification of normally transparent structures through which light rays pass to reach the retina (eg, cornea, vitreous) Retinal abnormalities Abnormalities affecting the optic nerve or visual pathways

Etiology
The most common causes of acute loss of vision are

Vascular occlusions of the retina (central retinal artery occlusion, central retinal vein occlusion) Ischemic optic neuropathy (often in patients with temporal arteritis) Vitreous hemorrhage (caused by diabetic retinopathy or trauma) Trauma

In addition, sudden recognition of loss of vision (pseudo-sudden loss of vision) may manifest initially as sudden onset. For example, a patient with long-standing reduced vision in one eye (possibly caused by a dense cataract) suddenly is aware of the reduced vision in the affected eye when covering the unaffected eye. Presence or absence of pain helps categorize loss of vision (see Table 1: Symptoms of
Ophthalmologic Disorders: Some Disorders That Cause Acute Vision Loss

).

Most disorders that cause total loss of vision when they affect the entire eye may affect only part of the eye and cause only a visual field defect (eg, branch occlusion of the retinal artery or retinal vein, focal retinal detachment).

Table 1

Some Disorders That Cause Acute Vision Loss


Cause Suggestive Findings Diagnostic Approach

Acute loss of vision without eye pain Arteritic ischemic optic neuropathy (usually in patients with giant cell [temporal] arteritis) Sometimes headache, jaw or tongue ESR claudication, temporal artery tenderness or Temporal artery biopsy swelling, pale and swollen disk with surrounding hemorrhages, occlusion of retinal artery or its branches Sometimes proximal myalgias with stiffness (due to polymyalgia rheumatica) Normal pupillary light reflexes, positive optokinetic nystagmus, no objective abnormalities on eye examination Often inability to write name or bring outstretched hands together Sometimes indifferent affect despite severity of claimed loss of vision Blood within or deep to retina in and around the macula Clinical evaluation If diagnosis is in doubt, ophthalmologic evaluation and visual evoked responses

Functional loss of vision

Macular hemorrhage due to neovascularization in agerelated macular degeneration Nonarteritic ischemic optic neuropathy

Clinical evaluation

Optic disk edema and hemorrhages Sometimes loss of inferior and central visual fields Risk factors (eg, diabetes, hypertension, hypotensive episode)

ESR Consideration of temporal artery biopsy to exclude giant cell arteritis

Ocular migraine

Scintillating scotomata, mosaic patterns, Clinical evaluation or complete loss of vision lasting usually 1060 min and often followed by headache Often in young patients Nearly instantaneous onset, pale retina, cherry-red fovea, sometimes Hollenhorst plaque (refractile object at the site of arterial occlusion) Risk factors for vascular disease Recent increase in floaters, photopsias (flashing lights), or both Visual field defect, retinal folds on ophthalmoscopy Risk factors (eg, trauma, eye surgery, severe myopia; in men, advanced age) Frequent, multiple, widely distributed retinal hemorrhages on ophthalmoscopy Risk factors (eg, diabetes, hypertension, hyperviscosity syndrome, sickle cell anemia) Bilaterally symmetric field defects, no effect on visual acuity in the intact parts of the visual field (bilateral occipital lesions are the exception and are uncommon but can occur due to basilar artery occlusion) Risk factors for atherosclerosis Previous floaters or spider web in vision Risk factors (eg, diabetes, retinal tear, sickle cell anemia, trauma) ESR to exclude giant cell arteritis

Retinal artery occlusion

Retinal detachment

Clinical evaluation

Retinal vein occlusion

Clinical evaluation

Transient ischemic attack or stroke

Consideration of MRI or CT Carotid ultrasonography ECG Continuous monitoring of cardiac rhythm Possible ultrasonography to assess retina

Vitreous hemorrhage

Acute loss of vision with eye pain

Acute angle-closure glaucoma

Halos around lights, nausea, headache, photophobia, conjunctival injection, corneal edema, shallow anterior chamber, intraocular pressure usually > 40 Ulcer visible with fluorescein staining, slitlamp examination, or both Risk factors (eg, injury, contact lens use, herpetic [painful vesicular] rash in V1 distribution) Floaters, fever, conjunctival injection, decreased red reflex, hypopyon, or a combination Risk factors (history of traumatic ruptured globe or intraocular foreign body [eg, after hammering metal on metal] or during eye surgery [usually after the 1st wk]) Mild pain with eye movement, afferent pupillary defect (occurs early) Central or peripheral visual field defects Abnormal color vision testing results Sometimes optic disk edema

Immediate ophthalmologic evaluation Gonioscopy Ophthalmologic evaluation

Corneal ulcer

Endophthalmitis

Immediate ophthalmologic evaluation with cultures of anterior chamber and vitreous fluids

Optic neuritis (usually painful but not always)

Gadolinium-enhanced MRI to diagnose multiple sclerosis

V1 = ophthalmic division of the trigeminal nerve.

Less common causes of acute loss of vision include

Anterior uveitis (a common disorder, but one that usually causes eye pain severe enough to trigger evaluation before vision is lost) Highly aggressive retinitis Certain drugs (eg, methanol, salicylates, ergot alkaloids, quinine )

Evaluation
History: History of present illness should describe loss of vision in terms of onset, duration, progression, and location (whether it is monocular or binocular and whether it involves the entire visual field or a specific part and which part). Important associated visual symptoms include floaters, flashing lights, halos around lights, distorted color vision, and jagged or mosaic patterns (scintillating scotomata). The patient should be asked about eye pain and whether it is constant or occurs only with eye movement. Review of systems should seek extraocular symptoms of possible causes, including jaw or tongue claudication, temporal headache, proximal muscle pain, and stiffness (giant cell arteritis); and headaches (ocular migraine). Past medical history should seek known risk factors for eye disorders (eg, contact lens use, severe myopia, recent eye surgery or injury), risk factors for vascular disease (eg, diabetes, hypertension), and hematologic disorders (eg, sickle cell anemia or disorders such as Waldenstrm's macroglobulinemia or multiple myeloma that could cause a hyperviscosity syndrome).

Family history should note any family history of migraine headaches. Physical examination: Vital signs, including temperature, are measured. If the diagnosis of a transient ischemic attack is under consideration, a complete neurologic examination is done. The facial skin is inspected for vesicles or ulcers in the V1 distribution (ophthalmic divsion of the trigeminal nerve), and the temples are palpated for pulses, tenderness, or nodularity over the course of the temporal artery. However, most of the examination focuses on the eye. Eye examination includes the following:

Visual acuity is measured. Peripheral visual fields are assessed by confrontation. Central visual fields are assessed by Amsler grid. Direct and consensual pupillary light reflexes are examined using the swinging flashlight test. Ocular motility is assessed. Color vision is tested with color plates. The eyelids, sclera, and conjunctiva are examined using a slit lamp if possible. The cornea is examined with fluorescein staining. The anterior chamber is examined for cells and flare in patients who have eye pain or conjunctival injection. The lens is checked for cataracts using a direct ophthalmoscope, slit lamp, or both. Intraocular pressure is measured. Ophthalmoscopy is done, preferably after dilating the pupil with a drop of a sympathomimetic (eg, 2.5% phenylephrine ), cycloplegic (eg, 1% cyclopentolate

or 1% tropicamide

), or both; dilation is nearly full after about 20 min. The entire fundus, including the retina, macula, fovea, vessels, and optic disk and its margins, is examined.

If pupillary light responses are normal and functional loss of vision is suspected (rarely), optokinetic nystagmus is checked. If an optokinetic drum is unavailable, a mirror can be held near the patient's eye and slowly moved. If the patient can see, the eyes usually track movement of the mirror.

Red flags: Acute loss of vision is itself a red flag; most causes are serious. Interpretation of findings: Diagnosis can be begun systematically. Fig. 1: Symptoms of
Ophthalmologic Disorders: Evaluation of acute vision loss.

describes a simplified, general approach.

Specific patterns of visual field deficit help suggest a cause (see Table 1: Approach to the
Ophthalmologic Patient: Types of Field Defects

). Other clinical findings also help suggest a cause ):

(see Table 1: Symptoms of Ophthalmologic Disorders: Some Disorders That Cause Acute Vision Loss

Difficulty seeing the red reflex during ophthalmoscopy suggests opacification of transparent structures (eg, caused by corneal ulcer, vitreous hemorrhage, or severe endophthalmitis). Retinal abnormalities that are severe enough to cause acute loss of vision are detectable during ophthalmoscopy, particularly if the pupils are dilated. Retinal detachment may show retinal folds; retinal vein occlusion may show marked retinal hemorrhages; and retinal artery occlusion may show pale retina with a cherry-red fovea. An afferent pupillary defect (absence of a direct pupillary light response but a normal consensual response) with an otherwise normal examination (except sometimes an abnormal optic disk) suggests an abnormality of the optic nerve or retina (ie, anterior to the chiasm).

In addition, the following facts may help:

Monocular symptoms suggest a lesion anterior to the optic chiasm. Bilateral, symmetric visual field defects suggest a lesion posterior to the chiasm. Constant eye pain suggests a corneal lesion (ulcer or abrasion), anterior chamber inflammation, or increased intraocular pressure, whereas eye pain with movement suggests optic neuritis. Temporal headaches suggest giant cell arteritis or migraine.

Fig. 1

Evaluation of acute vision loss.

Testing: ESR is done for all patients with symptoms (eg, temporal headaches, jaw claudication, proximal myalgias, stiffness) or signs (eg, temporal artery tenderness or induration, pale retina, papilledema) suggesting optic nerve or retinal ischemia to exclude giant cell arteritis. Other testing is listed in Table 1: Symptoms of Ophthalmologic Disorders: Some Disorders That Cause
Acute Vision Loss

. The following are of particular importance:

Ultrasonography is done to view the retina if the retina is not clearly visible with pupillary dilation and indirect ophthalmoscopy done by an ophthalmologist. Gadolinium-enhanced MRI is done for patients who have eye pain with movement or afferent pupillary defect, particularly with optic nerve swelling on ophthalmoscopy, to diagnose multiple sclerosis.

Treatment
Causative disorders are treated. Treatment should usually commence immediately if the cause is

treatable. In many cases (eg, vascular disorders), treatment is unlikely to salvage the affected eye but can decrease the risk of the same process occurring in the contralateral eye.

Key Points

Diagnosis and treatment should occur as rapidly as possible. Acute monocular loss of vision with an afferent pupillary defect indicates a lesion of the eye or of the optic nerve anterior to the optic chiasm. Optic nerve lesion, particularly ischemia, is considered in patients with acute monocular loss of vision or afferent pupillary defect and in those with or without optic nerve abnormalities on ophthalmoscopy but no other abnormalities on eye examination. Corneal ulcer, acute angle-closure glaucoma, endophthalmitis, or severe anterior uveitis is considered in patients with acute monocular loss of vision, afferent pupillary defect, eye pain, and conjunctival injection.

Diagnosis and Management of Red Eye in Primary Care


HOLLY CRONAU, MD; RAMANA REDDY KANKANALA, MD; and THOMAS MAUGER, MD, The Ohio State University College of Medicine, Columbus, Ohio
Am Fam Physician. 2010 Jan 15;81(2):137-144. Patient information: See related handout on pink eye, written by the authors of this article. Related letter: "Features and Serotypes of Chlamydial Conjunctivitis."

Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications are rare. Because there is no specific diagnostic test to differentiate viral from bacterial conjunctivitis, most cases are treated using broad-spectrum antibiotics. Allergies or irritants also may cause conjunctivitis. The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.

Red eye is one of the most common ophthalmologic conditions in the primary care setting. Inflammation of almost any part of the eye, including the lacrimal glands and eyelids, or faulty tear film can lead to red eye. Primary care physicians often effectively manage red eye, although knowing when to refer patients to an ophthalmologist is crucial.
SORT: KEY CLINICAL RECOMMENDATIONS

Clinical recommendation Good hygiene, such as meticulous hand washing, is important in decreasing the spread of acute viral conjunctivitis. Any ophthalmic antibiotic may be considered for the treatment of acute bacterial conjunctivitis because they have similar cure rates. Mild allergic conjunctivitis may be treated with an over-the-counter antihistamine/vasoconstrictor agent, or with a more effective secondgeneration topical histamine H receptor antagonist. Anti-inflammatory agents (e.g., topical cyclosporine [Restasis]), topical corticosteroids, and systemic omega-3 fatty acids are appropriate therapies for moderate dry eye. Patients with chronic blepharitis who do not respond adequately to eyelid hygiene and topical antibiotics may benefit from an oral tetracycline or
1

Evidence rating C A C

References 2,4 2326 15

32

4,33

Clinical recommendation doxycycline.

Evidence rating

References

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.xml.

Causes of Red Eye


Conjunctivitis is the most common cause of red eye and is one of the leading indications for antibiotics. Causes of conjunctivitis may be infectious (e.g., viral, bacterial, chlamydial) or noninfectious (e.g., allergies, irritants). Most cases of viral and bacterial conjunctivitis are selflimiting. Other common causes of red eye include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis.
1 2

A thorough patient history and eye examination may provide clues to the etiology of red eye (Figure 1). The history should include questions about unilateral or bilateral eye involvement, duration of symptoms, type and amount of discharge, visual changes, severity of pain, photophobia, previous treatments, presence of allergies or systemic disease, and the use of contact lenses. The eye examination should include the eyelids, lacrimal sac, pupil size and reaction to light, corneal involvement, and the pattern and location of hyperemia. Preauricular lymph node involvement and visual acuity must also be assessed. Common causes of red eye and their clinical presentations are summarized in Table 1.
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Diagnosis of the Underlying Cause of Red Eye

Figure 1.

Algorithm for diagnosing the cause of red eye.

TABLE 1.

Selected Differential Diagnosis of Red Eye


Condition Signs Conjunctivitis Viral Normal vision, normal pupil size and reaction to light, diffuse conjunctival injections (redness), preauricular lymphadenopat hy, lymphoid follicle on the undersurface of the eyelid Symptoms Causes Adenovirus (most common), enterovirus, coxsackievirus, VZV, Epstein-Barr virus, HSV, influenza

Mild to no pain, diffuse hyperemia, occasional gritty discomfort with mild itching, watery to serous discharge, photophobia (uncommon), often unilateral at onset with second eye involved within one or two days, severe cases may cause subepithelial corneal opacities and pseudomembra nes Herpes Vesicular rash, Pain and tingling zoster keratitis, uveitis sensation ophthalmicus precedes rash and conjunctivitis, typically unilateral with dermatomal involvement (periocular vesicles) Bacterial Eyelid edema, Mild to (acute and preserved moderate pain chronic) visual acuity, with stinging conjunctival sensation, red injection, eye with foreign normal pupil body sensation, reaction, no mild to corneal moderate involvement purulent discharge,

Herpes zoster

Common pathogens in children:Streptococcus pneumoniae, nontypeableHaemophilus influenzae Common pathogen in adults:Staphylococcus aureus Other pathogens:Staphylococcusspecies, Moraxellaspecies, Neisseria gonorrhoeae, gram-negative organisms (e.g., Escherichia coli), Pseudomonasspecies

Condition

Signs

Bacterial (hyperacute)

Chemosis with possible corneal involvement

Chlamydial Vision usually (inclusion preserved, conjunctivitis) pupils reactive to light, conjunctival injections, no corneal involvement, preauricular lymph node swelling is sometimes present Allergic Visual acuity preserved, pupils reactive to light, conjunctival injection, no corneal involvement, large cobblestone papillae under upper eyelid, chemosis Other causes Dry eye Vision usually (keratopreserved, conjunctivitis pupils reactive sicca) to light; hyperemia, no corneal involvement Blepharitis Dandruff-like scaling on eyelashes,

Symptoms Causes mucopurulent secretions with bilateral glued eyes upon awakening (best predictor) N. gonorrhoeae Severe pain; copious, purulent discharge; diminished vision Chlamydia trachomatis(serotypes D to K) Red, irritated eye; mucopurulent or purulent discharge; glued eyes upon awakening; blurred vision

Bilateral eye Airborne pollens, dust mites, animal dander, feathers, involvement; other environmental antigens painless tearing; intense itching; diffuse redness; stringy or ropy, watery discharge

Bilateral red, itchy eyes with foreign body sensation; mild pain; intermittent excessive watering Red, irritated eye that is worse upon

Imbalance in any tear component (production, distribution, evaporation, absorption); medications (anticholinergics, antihistamines, oral contraceptive pills); Sjgren syndrome

Chronic inflammation of eyelids (base of eyelashes or meibomian glands) by staphylococcal infection

Condition

Signs missing or misdirected eyelashes, swollen eyelids, secondary changes in conjunctiva and cornea leading to conjunctivitis Corneal Reactive abrasion and miosis, corneal foreign body edema or haze, possible foreign body, normal anterior chamber, visual acuity depends on the position of the abrasion in relation to visual axis Subconjuncti Normal vision; val pupils equal hemorrhage and reactive to light; well demarcated, bright red patch on white sclera; no corneal involvement

Symptoms waking; itchy, crusted eyelids

Causes

Unilateral or bilateral severe eye pain; red, watery eyes; photophobia; foreign body sensation; blepharospasm

Direct injury from an object (e.g., finger, paper, stick, makeup applicator); metallic foreign body; contact lenses

Mild to no pain, Spontaneous causes: hypertension, severe coughing, no vision straining, atherosclerotic vessels, bleeding disorders disturbances, no discharge

Episcleritis

Visual acuity preserved, pupils equal and reactive to light, dilated episcleral blood vessels, edema of episclera, tenderness over the area of injection, confined red patch Keratitis Diminished (corneal vision, corneal inflammation) opacities/white spot,

Mild to no pain; limited, isolated patches of injection; mild watering

Traumatic causes: blunt eye trauma, foreign body, penetrating injury Idiopathic (isolated presentation)

Painful red eye, diminished vision, photophobia,

Bacterial (Staphylococcusspecies,Streptococcus); viral (HSV, VZV, Epstein-Barr virus, cytomegalovirus); abrasion from foreign body; contact lenses

Condition

Iritis

Signs fluorescein staining under Wood lamp shows corneal ulcers, eyelid edema, hypopyon Diminished vision; poorly reacting, constricted pupils; ciliary/perilimba l injection

Symptoms mucopurulent discharge, foreign body sensation

Causes

Glaucoma Marked (acute angle- reduction in closure) visual acuity, dilated pupils react poorly to light, diffuse redness, eyeball is tender and firm to palpation Chemical Diminished burn vision, corneal involvement (common) Scleritis Diffuse redness, diminished vision, tenderness, scleral edema, corneal ulceration

Constant eye pain (radiating into brow/temple) developing over hours, watering red eye, blurred vision, photophobia Acute onset of severe, throbbing pain; watering red eye; halos appear when patient is around lights

Exogenous infection from perforating wound or corneal ulcer, autoimmune conditions

Obstruction to outflow of aqueous humor leading to increased intraocular pressure

Severe, painful red eye; photophobia Severe, boring pain radiating to periorbital area; pain increases with eye movements; ocular redness; watery discharge; photophobia; intense nighttime pain; pain upon awakening

Common agents include cement, plaster powder, oven cleaner, and drain cleaner

Systemic diseases, such as rheumatoid arthritis, Wegener granulomatosis, reactive arthritis, sarcoidosis, inflammatory bowel disease, syphilis, tuberculosis

HSV = herpes simplex virus; VZV = varicella-zoster virus. Information from references 2 through 11.

Diagnosis and Treatment

VIRAL CONJUNCTIVITIS

Viral conjunctivitis (Figure 2) caused by the adenovirus is highly contagious, whereas conjunctivitis caused by other viruses (e.g., herpes simplex virus [HSV]) are less likely to spread. Viral conjunctivitis usually spreads through direct contact with contaminated fingers, medical instruments, swimming pool water, or personal items. It is often associated with an upper respiratory infection spread through coughing. The clinical presentation of viral conjunctivitis is usually mild with spontaneous remission after one to two weeks. Treatment is supportive and may include cold compresses, ocular decongestants, and artificial tears. Topical antibiotics are rarely necessary because secondary bacterial infections are uncommon.
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To prevent the spread of viral conjunctivitis, patients should be counseled to practice strict hand washing and avoid sharing personal items; food handlers and health care workers should not work until eye discharge ceases; and physicians should clean instruments after every use. Referral to an ophthalmologist is necessary if symptoms do not resolve after seven to 10 days or if there is corneal involvement. Topical corticosteroid therapy for any cause of red eye is used only under direct supervision of an ophthalmologist. Suspected ocular herpetic infection also warrants immediate ophthalmology referral.
13 4 5,12

Figure 2. Viral conjunctivitis with intensely hyperemic conjunctiva, perilimbal sparing, and watery discharge. BACTERIAL CONJUNCTIVITIS

Bacterial conjunctivitis is highly contagious and is most commonly spread through direct contact with contaminated fingers. Based on duration and severity of signs and symptoms, bacterial conjunctivitis is categorized as hyperacute, acute, or chronic.
2 4,12

Hyperacute bacterial conjunctivitis (Figure 3 ) is often associated with Neisseria gonorrhoeae in sexually active adults. The infection has a sudden onset and progresses rapidly, leading to corneal perforation. Hyperacute bacterial conjunctivitis is characterized by copious, purulent discharge; pain; and diminished vision loss. Patients need prompt ophthalmology referral for aggressive management. Acute bacterial conjunctivitis is the most common form of bacterial conjunctivitis in the primary care setting. Signs and symptoms persist for less than three to four weeks. Staphylococcus aureus infection often causes acute bacterial conjunctivitis in adults,
14 4,12

whereas Streptococcus pneumoniae andHaemophilus influenzae infections are more common causes in children. Chronic bacterial conjunctivitis is characterized by signs and symptoms that persist for at least four weeks with frequent relapses. Patients with chronic bacterial conjunctivitis should be referred to an ophthalmologist.
2

Figure 3. Hyperacute bacterial conjunctivitis with reac-cumulating, copious, purulent discharge; severe pain; chemosis with corneal involvement; and eyelid swelling. Prompt referral to an ophthalmologist is needed. Reprinted with permission from Fay A. Diseases of the visual system. In: Goldman L, Ausillo D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders; 2007.

Laboratory tests to identify bacteria and sensitivity to antibiotics are performed only in patients with severe cases, in patients with immune compromise, in contact lens wearers, in neonates, and when initial treatment fails. Generally, topical antibiotics have been prescribed for the treatment of acute infectious conjunctivitis because of the difficulty in making a clinical distinction between bacterial and viral conjunctivitis. Benefits of antibiotic treatment include quicker recovery, early return to work or school, prevention of further complications, and decreased future physician visits.
4,15 2,6,16

A meta-analysis based on five randomized controlled trials showed that bacterial conjunctivitis is self-limiting (65 percent of patients improved after two to five days without antibiotic treatment), and that severe complications are rare. Studies show that bacterial pathogens are isolated from only 50 percent of clinically diagnosed bacterial conjunctivitis cases. Moreover, the use of antibiotics is associated with increased antibiotic resistance, additional expense for patients, and the medicalization of minor illness. Therefore, delaying antibiotic therapy is an option for acute bacterial conjunctivitis in many patients (Table 2). A shared decision-making approach is appropriate, and many patients are willing to delay antibiotic therapy when counseled about the self-limiting nature of the disease. Some schools require proof of antibiotic treatment for at least two days before readmitting students, and this should be addressed when making treatment decisions.
2,7,1619 8,16 4,2022 2,9 7

TABLE 2.

Management Options for Suspected Acute Bacterial Conjunctivitis


Management option Patient group

Management option Consider immediate antibiotic therapy

Consider delaying antibiotic therapy

Patient group Health care workers Patients who are in a hospital or other health care facility Patients with risk factors, such as immune compromise, uncontrolled diabetes mellitus, contact lens use, dry eye, or recent ocular surgery Children going to schools or day care centers that require antibiotic therapy before returning Patients without risk factors who are well informed and have access to followup care Patients without risk factors who do not want immediate antibiotic therapy

Information from references 2 and 9.

Studies comparing the effectiveness of different ophthalmic antibiotics did not show one to be superior. The choice of antibiotic (Table 3) should be based on cost-effectiveness and local bacterial resistance patterns. If the infection does not improve within one week of treatment, the patient should be referred to an ophthalmologist.
2326 4,5

TABLE 3.

Ophthalmic Therapies for Acute Bacterial Conjunctivitis


In retail discount programs

Therapy Azithromycin 1% (Azasite)

Besifloxacin 0.6% (Besivance) Ciprofloxacin 0.3% (Ciloxan)

Erythromycin 0.5% Gatifloxacin 0.3% (Zymar) or moxifloxacin 0.5% (Vigamox) Gentamicin 0.3% (Gentak)

Levofloxacin 1.5% (Iquix) or 0.5% (Quixin)

Usual dosage Solution: One drop two times daily (administered eight to 12 hours apart) for two days, then one drop daily for five days Solution: One drop three times daily for one week Ointment: 0.5-inch ribbon applied in conjunctival sac three times daily for one week Solution: One or two drops four times daily for one week Ointment: 0.5-inch ribbon applied four times daily for one week Solution: One drop three times daily for one week Ointment: 0.5-inch ribbon applied four times daily for one week Solution: One to two drops four times daily for one week Solution: One or two drops four times daily for one week

Cost of generic (brand)* NA ($82) for 5 mL

NA ($85) for 5 mL Ointment: NA ($99) for 3.5 gSolution: $30 ($65) for 5 mL

$13 (NA) for 3.5 g NA ($84) for 5 mL

Ofloxacin 0.3% (Ocuflox)

Solution: One or two drops four times daily for one week Sulfacetamide 10% (Bleph-10) Ointment: Apply to lower

Ointment: NA ($22) for 3.5 g Solution: $15 ($18) for 15 mL 1.5%: NA ($89) for 5 mL 0.5%: NA ($57) for 5 mL $44 ($80) for 5 mL $13 ($22) for 5 mL

Therapy

Tobramycin 0.3% (Tobrex)

Trimethoprim/polymyxin B (Polytrim)
NOTE:

Usual dosage conjunctival sac four times daily and at bedtime for one week Solution: One or two drops every two to three hours for one week Ointment: 0.5-inch ribbon applied in conjunctival sac three times daily for one week Solution: One to two drops four times daily for one week Solution: One or two drops four times daily for one week

Cost of generic (brand)*

In retail discount programs

Ointment: NA ($76) for 3.5 g Solution: $16 ($60) for 5 mL NA ($42) for 10 mL

Supportive care for acute bacterial conjunctivitis includes warm compresses and eye irrigation, but eye patching should be avoided. Although chloramphenicol is the first-line treatment in other countries, it is no longer available in the United States. In patients who wear contact lenses, pseudomonal coverage is essential; quinolones are highly effective against Pseudomonas. NA = not available. * Estimated retail price based on information obtained at http://www.drugstore.com and Walgreens (November 2009). Generic price listed first; brand price listed in parentheses. May be available at discounted prices ($10 or less for one month's treatment) at one or more national retail chains. Topical fluoroquinolones are highly effective and should be reserved for severe infections. Gatifloxacin and moxifloxacin have improved coverage against ciprofloxacin-resistant organisms, but decreased activity against Pseudomonas. CHLAMYDIAL CONJUNCTIVITIS

Chlamydial conjunctivitis should be suspected in sexually active patients who have typical signs and symptoms and do not respond to standard antibacterial treatment. Patients with chlamydial infection also may present with chronic follicular conjunctivitis. Polymerase chain reaction testing of conjunctival scrapings is diagnostic, but is not usually needed. Treatment includes topical therapy with erythromycin ophthalmic ointment, and oral therapy with azithromycin (Zithromax; single 1-g dose) or doxycycline (100 mg twice a day for 14 days) to clear the genital infection. The patient's sexual partners also must be treated.
2 4

ALLERGIC CONJUNCTIVITIS

Allergic conjunctivitis is often associated with atopic diseases, such as allergic rhinitis (most common), eczema, and asthma. Ocular allergies affect an estimated 25 percent of the population in the United States. Itching of the eyes is the most apparent feature of allergic conjunctivitis. Seasonal allergic conjunctivitis is the most common form of the condition, and symptoms are related to season-specific aeroallergens. Perennial allergic conjunctivitis persists throughout the year. Allergic conjunctivitis is primarily a clinical diagnosis.
27 28

Avoiding exposure to allergens and using artificial tears are effective methods to alleviate symptoms. Over-the-counter antihistamine/vasoconstrictor agents are effective in treating mild allergic

conjunctivitis. Another, more effective, option is a second-generation topical histamine H receptor antagonist. Table 4 presents ophthalmic therapies for allergic conjunctivitis.
1 15

TABLE 4.

Ophthalmic Therapies for Allergic Conjunctivitis


Cost of generic (brand)* $140 ($108) for 6 mL NA ($72) for 5 mL $32 ($45) for 10 mL NA ($98) for 10 mL NA ($90) for 5 mL

Therapy Histamine H receptor antagonists Azelastine 0.05% (Optivar)


1

Usual dosage One drop twice daily One drop four times daily One or two drops every four to six hours One or two drops four times daily One or two drops twice daily One drop every eight to 12 hours One drop twice daily One drop four times daily

Emedastine 0.05% (Emadine) Mast cell stabilizers Cromolyn sodium 4% (Crolom) Lodoxamide 0.1% (Alomide) Nedocromil 2% (Alocril) Mast cell stabilizers and H receptor antagonists Ketotifen 0.025% (Zaditor; available over the counter as Alaway) Olopatadine 0.1% (Patanol) Nonsteroidal anti-inflammatory drugs Ketorolac 0.5% (Acular)
1

NA ($70) for 5 mL NA ($96) for 5 mL $110 ($161) for 5 mL

Vasoconstrictor/antihistamine Naphazoline/pheniramine (available over the counter as One or two drops up to four NA ($6 to $11) for Opcon-A, Visine-A) times daily 15 mL
NOTE:

Severe cases may require topical corticosteroids and ophthalmology referral.

NA = not available. * Estimated retail price based on information obtained at http://www.drugstore.com and Walgreens (November 2009). Generic price listed first; brand price listed in parentheses. None of these therapies are offered in retail discount programs. Relieves itching immediately. Treats mild allergic conjunctivitis. Takes time for effect to be apparent. Treats mild to moderately severe allergic conjunctivitis. Used for short-term relief of mild allergic conjunctivitis. This therapy is less expensive than others. DRY EYE

Dry eye (keratoconjunctivitis sicca) is a common condition caused by decreased tear production or poor tear quality. It is associated with increased age, female sex, medications (e.g., anticholinergics), and some medical conditions. Diagnosis is based on clinical presentation and diagnostic tests. Tear osmolarity is the best single diagnostic test for dry eye. The overall accuracy of the diagnosis increases when tear osmolarity is combined with assessment of tear turnover rate and evaporation. Some patients with dry eye may have ocular discomfort without tear film abnormality on
29 30,31

examination. In these patients, treatment for dry eye can be initiated based on signs and symptoms. If Sjgren syndrome is suspected, testing for autoantibodies should be performed. Treatment includes frequent applications of artificial tears throughout the day and nightly application of lubricant ointments, which reduce the rate of tear evaporation. The use of humidifiers and wellfitting eyeglasses with side shields can also decrease tear loss. If artificial tears cause itching or irritation, it may be necessary to switch to a preservative-free form or an alternative preparation. When inflammation is the main factor in dry eye, cyclosporine ophthalmic drops (Restasis) may increase tear production. Topical cyclosporine may take several months to provide subjective improvement. Systemic omega-3 fatty acids have also been shown to be helpful. Topical corticosteroids are shown to be effective in treating inflammation associated with dry eye. The goal of treatment is to prevent corneal scarring and perforation. Ophthalmology referral is indicated if the patient needs topical steroid therapy or surgical procedures.
5 32 32

BLEPHARITIS

Blepharitis is a chronic inflammatory condition of the eyelid margins and is diagnosed clinically. Patients should be examined for scalp or facial skin flaking (seborrheic dermatitis), facial flushing, and redness and swelling on the nose or cheeks (rosacea). Treatment involves eyelid hygiene (cleansing with a mild soap, such as diluted baby shampoo, or eye scrub solution), gentle lid massage, and warm compresses. This regimen should continue indefinitely. Topical erythromycin or bacitracin ophthalmic ointment applied to eyelids may be used in patients who do not respond to eyelid hygiene. Azithromycin eye drops may also be used in the treatment of blepharitis. In severe cases, prolonged use of oral antibiotics (doxycycline or tetracycline) may be beneficial. Topical steroids may also be useful for severe cases.
33 30

CORNEAL ABRASION

Corneal abrasion is diagnosed based on the clinical presentation and eye examination. If needed, short-term topical anesthetics may be used to facilitate the eye examination. Fluorescein staining under a cobalt blue filter or Wood lamp is confirmatory. A branching pattern of staining suggests HSV infection or a healing abrasion. HSV infection with corneal involvement warrants ophthalmology referral within one to two days. In patients with corneal abrasion, it is good practice to check for a retained foreign body under the upper eyelid. Treatment includes supportive care, cycloplegics (atropine, cyclopentolate [Cyclogyl], homatropine, scopolamine, and tropicamide), and pain control (topical nonsteroidal anti-inflammatory drugs [NSAIDs] or oral analgesics). The need for topical antibiotics for uncomplicated abrasions has not been proven. Topical aminoglycosides should be avoided because they are toxic to corneal epithelium. Studies show that eye patches do not improve patient comfort or healing of corneal abrasion. All steroid preparations are contraindicated in patients with corneal abrasion. Referral to an ophthalmologist is indicated if symptoms worsen or do not resolve within 48 hours.
34 35

SUBCONJUNCTIVAL HEMORRHAGE

Subconjunctival hemorrhage is diagnosed clinically. It is harmless, with blood reabsorption over a few weeks, and no treatment is needed. Warm compresses and ophthalmic lubricants (e.g., hydroxypropyl cellulose [Lacrisert], methylcellulose [Murocel], artificial tears) may relieve

symptoms. If pain is present, a cause must be identified. It is good practice to check for corneal involvement or penetrating injury, and to consider urgent referral to ophthalmology. Recurrent hemorrhages may require a workup for bleeding disorders. If the patient is taking warfarin (Coumadin), the International Normalized Ratio should be checked.
EPISCLERITIS

Episcleritis is a localized area of inflammation involving superficial layers of episclera. It is usually self-limiting (lasting up to three weeks) and is diagnosed clinically. Investigation of underlying causes is needed only for recurrent episodes and for symptoms suggestive of associated systemic diseases, such as rheumatoid arthritis. Treatment involves supportive care and use of artificial tears. Topical NSAIDs have not been shown to have significant benefit over placebo in the treatment of episcleritis. Topical steroids may be useful for severe cases. Ophthalmology referral is required for recurrent episodes, an unclear diagnosis (early scleritis), and worsening symptoms.
36

The Authors
HOLLY CRONAU, MD, is an associate professor of clinical medicine in the Department of Family Medicine at The Ohio State University (OSU) College of Medicine, Columbus, and is director of the department's Family Medicine Clerkship. RAMANA REDDY KANKANALA, MD, is a third-year resident in the Department of Family Medicine at OSU College of Medicine. THOMAS MAUGER, MD, is an associate professor in and chief of the Department of Ophthalmology at OSU College of Medicine. Address correspondence to Holly Cronau, MD, The Ohio State University, B0902B Cramblett Hall, 456 W. 10th Ave., Columbus, OH 43210 (e-mail: holly.cronau@osumc.edu). Reprints are not available from the authors. Author disclosure: Nothing to disclose.

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2. Hvding G. Acute bacterial conjunctivitis. Acta Ophthalmol. 2008;86(1):517. 3. Wirbelauer C. Management of the red eye for the primary care physician. Am J Med. 2006;119(4):302306. 4. Leibowitz HM. The red eye. N Engl J Med. 2000;343(5):345351. 5. Galor A, Jeng BH. Red eye for the internist: when to treat, when to refer. Cleve Clin J Med. 2008;75(2):137
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7. Rose PW, Harnden A, Brueggemann AB, et al. Chloramphenicol treatment for acute infective conjunctivitis in
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8. Rietveld RP, van Weert HC, ter Riet G, et al. Diagnostic impact of signs and symptoms in acute infectious
conjunctivitis. BMJ. 2003;327(7418):789. 9. Everitt HA, Little PS, Smith PW. A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice [published correction appears in BMJ. 2006;333(7566):468]. BMJ. 2006;333(7563):321. 10. Wagner RS, Aquino M. Pediatric ocular inflammation. Immunol Allergy Clin North Am. 2008;28(1):169188. 11. Buznach N, Dagan R, Greenberg D. Clinical and bacterial characteristics of acute bacterial conjunctivitis in children in the antibiotic resistance era. Pediatr Infect Dis J. 2005;24(9):823828.

12. Morrow GL, Abbott RL. Conjunctivitis. Am Fam Physician. 1998;57(4):735746. 13. Azar MJ, Dhaliwal DK, Bower KS, et al. Possible consequences of shaking hands with your patients with
epidemic keratoconjunctivitis. Am J Ophthalmol. 1996;121(6):711712.

14. Fay A. Diseases of the visual system. In: Goldman L, Ausillo D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa.:
Saunders; 2007.

15. American Academy of Ophthalmology. Preferred practice patterns. Conjunctivitis. September


2008.http://one.aao.org/CE/PracticeGuidelines/PPP.aspx. Accessed September 3, 2009.

16. Sheikh A, Hurwitz B. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst
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17. Sheikh A, Hurwitz B. Topical antibiotics for acute bacterial conjunctivitis. Br J Gen Pract. 2005;55(521):962
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18. Sheikh A, Hurwitz B. Topical antibiotics for acute bacterial conjunctivitis: a systematic review. Br J Gen
Pract. 2001;51(467):473477. 19. Wickstrm K. Acute bacterial conjunctivitisbenefits versus risks with antibiotic treatment. Acta Ophthalmol. 2008;86(1):24. 20. Block SL, Hedrick J, Tyler R, et al. Increasing bacterial resistance in pediatric acute conjunctivitis. Antimicrob Agents Chemother. 2000;44(6):16501654. 21. Goldstein MH, Kowalski RP, Gordon YJ. Emerging fluoroquinolone resistance in bacterial keratitis. Ophthalmology. 1999;106(7):13131318. 22. Little P, Gould C, Williamson I, et al. Reattendance and complications in a randomised trial of prescribing strategies for sore throat. BMJ. 1997;315(7104):350352. 23. Trimethoprim-polymyxin B sulphate ophthalmic ointment versus chloramphenicol ophthalmic ointment in the treatment of bacterial conjunctivitis J Antimicrob Chemother. 1989;23(2):261266. 24. Jauch A, Fsadni M, Gamba G. Meta-analysis of six clinical phase III studies comparing lomefloxacin 0.3% eye drops twice daily to five standard antibiotics in patients with acute bacterial conjunctivitis. Graefes Arch Clin Exp Ophthalmol. 1999;237(9):705713. 25. Lohr JA, Austin RD, Grossman M, et al. Comparison of three topical antimicrobials for acute bacterial conjunctivitis. Pediatr Infect Dis J. 1988;7(9):626629. 26. Protzko E, Bowman L, Abelson M, et al. Phase 3 safety comparisons for 1.0% azithromycin in polymeric mucoadhesive eye drops versus 0.3% tobramycin eye drops for bacterial conjunctivitis. Invest Ophthalmol Vis Sci. 2007;48(8):34253429. 27. Bielory L, Friedlaender MH. Allergic conjunctivitis. Immunol Allergy Clin North Am. 2008;28(1):4358. 28. Granet D. Allergic rhinoconjunctivitis and differential diagnosis of the red eye. Allergy Asthma Proc. 2008;29(6):565574. 29. Schaumberg DA, Sullivan DA, Buring JE, et al. Prevalance of dry eye syndrome among U.S. women. Am J Ophthalmol. 2003;136(2):318326. 30. Jackson WB. Blepharitis: current strategies for diagnosis and management. Can J Ophthalmol. 2008;43(2):170179. 31. Tomlinson A, Khanal S, Ramaesh K, et al. Tear film osmolarity: determination of a referent for dry eye diagnosis. Invest Ophthalmol Vis Sci. 2006;47(10):43094315. 32. American Academy of Ophthalmology. Preferred practice patterns. Dry eye syndrome.http://one.aao.org/CE/PracticeGuidelines/PPP.aspx. Accessed September 3, 2009. 33. American Academy of Ophthalmology. Preferred practice pattern. Blepharitis.http://one.aao.org/CE/PracticeGuidelines/PPP.aspx. Accessed September 3, 2009. 34. Tullo A. Pathogenesis and management of herpes simplex virus keratitis. Eye. 2003;17(8):919922. 35. Turner A, Rabiu M. Patching for corneal abrasion. Cochrane Database Syst Rev. 2006(2):CD004764. 36. Williams CP, Browning AC, Sleep TJ, et al. A randomised, double-blind trial of topical ketorolac vs artificial tears for the treatment of episcleritis. Eye. 2005;19(7):739742.

Eye Disorders
Approach to the Ophthalmologic Patient Ophthalmic Anatomy Evaluation of the Ophthalmologic Patient Symptoms of Ophthalmologic Disorders Acute Vision Loss Anisocoria Blurred Vision Diplopia Eyelid Swelling Eye Pain Proptosis Floaters Red Eye Tearing Other Eye Symptoms Refractive Error Overview of Refractive Error Contact Lenses Refractive Surgery Eyelid and Lacrimal Disorders Blepharitis Blepharospasm Canaliculitis Chalazion and Hordeolum (Stye) Dacryocystitis Dacryostenosis Entropion and Ectropion Trichiasis Eyelid Growths Conjunctival and Scleral Disorders Overview of Conjunctival and Scleral Disorders Cicatricial Pemphigoid Conjunctivitis Trachoma Other Conjunctival Disorders Episcleritis Scleritis Corneal Disorders Introduction Bullous Keratopathy Corneal Ulcer Herpes Simplex Keratitis Glaucoma Overview of Glaucoma Primary Open-Angle Glaucoma Angle-Closure Glaucoma Cataract Cataract Uveitis and Related Disorders Uveitis Sympathetic Ophthalmia Retinal Disorders Age-Related Macular Degeneration (AMD or ARMD) Central Retinal Artery Occlusion Central Retinal Vein Occlusion Diabetic Retinopathy Hypertensive Retinopathy Retinal Detachment Retinitis Pigmentosa Epiretinal Membrane Cancers Affecting the Retina Optic Nerve Disorders The Optic Pathway Hereditary Optic Neuropathies Ischemic Optic Neuropathy Optic Neuritis Papilledema Toxic Amblyopia Orbital Diseases Introduction Cavernous Sinus Thrombosis Inflammatory Orbital Disease Preseptal and Orbital Cellulitis Tumors of the Orbit

Herpes Zoster Ophthalmicus Interstitial Keratitis Keratoconjunctivitis Sicca Keratoconus Keratomalacia Peripheral Ulcerative Keratitis Phlyctenular Keratoconjunctivitis Superficial Punctate Keratitis Corneal Transplantation

Diagnosis
As mentioned before Dry Eye is multifactorial. Accurate diagnosis will mean that the treating optometrist will be able to minimize treatment options. To demonstrate how complex this can be have a look at the following diagram that has been borrowed from the TFOS website. It is complex and we think makes it clear that if dry eyes are moderately bothersome need to be assessed by an expert in dry eye management. The investigation process needs to extensive so as to come to an accurate diagnosis and ultimately the most efficient and effective treatment. Due to its complexity Dry Eye diagnosis can be as simple as asking a few questions as part of a normal eye examination to as complex as a separate specific battery of tests possibly repeated on different days.

The following could represents a simple but thorough 5 minute Dry Eye evaluation:

1. 2. 3. 4. 5. 6.

What irritates you most about your eyes? When is this most likely to occur? Are there specific environments that make things worse? Can you wake up in the morning with redness or a burning sensation? Do you use non-prescription drops or ointments and do they help? Do you take any systemic medications? Many medications have dry eye side effects.

Answers to these very important questions will flag specific strategy for the Dry Eye expert. After questioning, the following observations should be made through a microscope device called a Slit Lamp Biomicroscope: Look for dandruff like flakes or debris on the eye lashes this is a sign of a condition called blepharitis. Look for eye lid anomalies Assessment of the meibomian glands. These glands produce the oil that is the top layer of the tear film. Look for redness and inflammation of the eye lid margins. Look for redness and inflammation of the bulbar and palpebral conjunctiva. Assess tear film volume by observation and then measure tear film production by standardized tests either the Schirmers or Phenol Thread.

Please forgive the medical jargon that has been used describing this testing protocol. The language is well beyond the purpose of this document but serves to create a rough understanding of the complexity of Dry Eye assessment. In the hands of an efficient experienced optometrist this whole protocol should not take more than 5 minutes. Something as extensive as this type of protocol, should be done at least once on any patient that presents with symptoms of dry eyes. There is also great merit in performing this type of evaluation on any new contact lens wearer since wearing contact lenses can exacerbate an underlying dormant dry eye condition. So if the above was the simple test what could possibly be involved in a comprehensive Dry Eye evaluation? Other than all the steps above you could add: Tear Film Osmolarity This relatively advanced and new test has FDA approval in the USA and seems to make sense although the jury is still out amongst dry eye experts how accurate it is in distinguishing dry eye syndrome. Meibomian Oil Quality using a sophisticated instrument the expert dry eye practitioner can now assess the very important oil using a Lipiflow Ocular Surface Interferometer.

http://www.klikdokter.com/tanyadokter/read/2011/08/01/13451/keluhan-mata-gatal Keluhan Mata Gatal Dokter, saya setiap hari beraktifitas menggunakan sepeda motor, setalah sekian lama saya merasakan mata saya sering gatal-gatal. apa solisinya ya Dok?

Bapak/Saudara yang Terhormat. Terima kasih telah menggunakan layanan e-konsultasi Klikdokter. Mata gatal dapat terjadi akibat beberapa hal, diantaranya :
o o o o o

Alergi Kojungtivitis, baik konjungtivitis bakteri, konjungtivitis virus, dll Mata kering akibat kurangnya air mata Entropion, yaitu suatu kondisi dimana bagian tepi kelopak mata melipat kedalam sehingga bulu mata menggesek permukaan mata. Biasa terjadi pada orang tua. Dll.

Karena banyaknya kemungkinan penyebab terjadinya mata gatal, maka perlu dilakukan pemeriksaan lebih lanjut untuk memastikan penyebab timbulnya keluhan gatal pada mata Anda. Pengobatan akan diberikan sesuai dengan diagnosis yang ditegakkan oleh dokter melalui wawancara dan pemeriksaan mata secara langsung. Jika mata gatal disebabkan oleh alergi dokter akan memberikan obat anti alergi (antihistamin) atau tetes mata steroid, jika disebabkan oleh infeksi bakteri atau virus maka dokter akan memberikan tetes mata antibiotik atau antivirus, jika disebabkan oleh berkurangnya air mata maka dokter akan memberikan air mata buatan, dan lain sebagainya. Periksakanlah mata Anda ke dokter. Penegakkan diagnosis yang lebih dini akan memberikan hasil yang lebih baik.

Demikian informasi yang dapat kami sampaikan. Semoga bermanfaat. (JF) Salam, Tim Redaksi Klikdokter

KONJUNGTIVITAS ( Mata Belekan )


Jakarta, Deskripsi Konjungtivitis (mata merah) adalah suatu peradangan atau infeksi membran transparan (konjungtiva) yang melapisi kelopak mata dan bagian dari bola mata. Peradangan menyebabkan pembuluh darah kecil di konjungtiva menjadi lebih menonjol, sehingga menyebabkan bagian putih pada mata terlihat kemerahan. Penyebab mata merah umumnya infeksi bakteri atau virus, reaksi alergi atau terbukanya sebuah saluran air mata yang tidak sempurna pada bayi. Meskipun konjungtivitis menjengkelkan, namun jarang berpengaruh pada penglihatan. Tetapi karena konjungtivitis dapat menular, diagnosis dini dan pengobatan yang terbaik dapat membantu mencegah penularannya. Penyebab Penyebab konjungtivitis, antara lain: 1. Virus 2. Bakteri 3. Alergi 4. Percikan bahan kimia pada mata 5. Adanya benda asing di mata 6. Saluran air mata tersumbat pada bayi baru lahir Gejala Gejala yang paling umum pada konjungtivitis, antara lain: 1. Kemerahan pada satu atau kedua mata 2. Gatal pada satu atau kedua mata 3. Sensasi berpasir pada satu atau kedua mata 4. Keluar cairan pada satu atau kedua mata yang membentuk kerak (mengeras) pada malam hari Kapan harus berkonsultasi dengan dokter? Jika terjadi gejala-gejala konjungtivitis pada mata, maka segeralah berkonsultasi dengan dokter. Konjungtivitis dapat sangat menular selama dua minggu setelah tanda-tanda dan gejala dimulai. Dengan diagnosis dini dapat melindungi orang di sekitar dari tertularnya konjungtivitis. Mendapatkan pengobatan juga dapat membantu mengatasi gejala-gejala dan mengurangi risiko komplikasi. Pengobatan 1. Pengobatan untuk konjungtivitis karena bakteri a. Tetes mata antibakteri Jika konjungtivitis akibat dari infeksi bakteri, dokter mungkin meresepkan obat tetes mata antibiotik, dan infeksi dapat sembuh dalam beberapa hari. b. Salep mata antibiotik Salep mata antibiotik kadang-kadang diresepkan untuk mengobati konjungtivitis pada anakanak. Salep sering lebih mudah diberikan pada bayi daripada obat tetes mata, meskipun salep dapat mengaburkan penglihatan selama 20 menit setelah aplikasi. Ikuti petunjuk dokter dan gunakan antibiotik sampai resep habis, untuk mencegah terulangnya infeksi. 2. Pengobatan untuk konjungtivitis karena virus

Tidak ada pengobatan untuk sebagian besar kasus konjungtivitis virus. Sebaliknya, konjungtivitis karena virus dapat sembuh dengan sendirinya selama 2-3 minggu. Konjungtivitis virus sering dimulai pada satu mata dan kemudian menginfeksi mata yang lain dalam beberapa hari. Obat antivirus mungkin menjadi pilihan, jika dokter menentukan bahwa konjungtivitis virus disebabkan oleh virus herpes simpleks. 3. Pengobatan untuk konjungtivitis karena alergi Jika yang mengiritasi mata adalah konjungtivitis alergi, dokter mungkin meresepkan salah satu dari berbagai jenis obat tetes mata untuk alergi. Ini mungkin termasuk antihistamin, dekongestan, mast cell stabilizers, steroid dan tetes anti-inflamasi. Bila memungkinkan, mengurangi keparahan gejala konjungtivitis karena alergi juga dapat dilakukan dengan menghindari penyebab alergi.

Konsul Infeksi/Belekan
Konjungtivitis adalah peradangan/infeksi pada konjungtiva (selaput bening yang melapisi mata). Penyakit ini ditandai dengan mata merah, berair, ada kotoran mata (belekan), lengket seperti ada benda asing, kadang-kadang bengkak. Bisa menyerang bayi baru lahir hingga orang tua. Bila terjadi dalam waktu 12 hingga 24 jam disebut hiperakut, akut bila kurang dari 4 minggu dan kronis lebih dari 1 bulan. Penyebab konjungtivitis ini bermacam-macam, seperti bahan kimia, obat-obat tetes mata, alergi (debu, serbuk, bulu, angin, asap, parasit, hingga penggunaan lensa kontak yang kurang bersih), bakteri, virus (paling seringAdenovirus), kutu, bahkan dikarenakan Penyakit Menular Seksual (PMS) seperti Gonorrehoea (kencing nanah,) Chlamydia, Molluscum contagiosum. Penanganannya disesuaikan dengan faktor penyebabnya. Umumnya ditangani dengan kompres mata air dingin, pemberian air mata buatan, pemberian vasokonstriktor/anti histamin, antibiotik. Penggunaan obat atau salep antibiotik harus sesuai resep dokter dan tangan harus selalu bersih saat penggunaan obat. Disarankan agar penyakit ini tidak menyebar pada orang lain, sering mencuci tangan, tidak menggunakan peralatan makan atau mandi secara bersamaan. (resensi oleh Dr. Rose Setiawan, SpM, MSc) NB: *Pertanyaan konsultasi online yang sifatnya tidak penting/bercanda/mengandung unsur SARA/kurang sopan/tidak berbahasa Indonesia yang baik, akan langsung dihapus dari forum ini. **Cantumkan Nama (asli atau alias)/Jenis kelamin/Usia/Riwayat penyakit/Pertanyaan dengan jelas.

Konjungtivitis

Bagi Ini

Peradangan konjungtiva biasanya hasil dari infeksi, alergi iritasi, atau. Gejala hiperemi konjungtiva dan debit mata dan, tergantung pada ketidaknyamanan, etiologi dan gatalgatal.Diagnosis klinis adalah, kadang-kadang budaya ditunjukkan. Pengobatan tergantung pada etiologi dan mungkin termasuk antibiotik topikal, antihistamin, stabilisator sel mast, dan kortikosteroid. Konjungtivitis menular yang paling umum virus atau bakteri dan menular. Jarang, patogen campuran atau dikenali hadir. Banyak alergen dapat menyebabkan konjungtivitis alergi (lihatGangguan konjungtiva dan scleral: Konjungtivitis alergi ). Iritasi konjungtiva nonallergic dapat hasil dari benda asing, angin, debu, asap, asap, uap kimia, dan jenis-jenis polusi udara, dan sinar ultraviolet intens busur listrik, sunlamps, dan refleksi dari salju. Konjungtivitis biasanya akut, namun kedua kondisi infeksi dan alergi dapat menjadi kronis.Kondisi yang menyebabkan konjungtivitis kronis termasuk ectropion, entropion, blepharitis, dan dacryocystitis kronis.

Gejala dan Tanda


Setiap sumber peradangan menyebabkan lakrimasi atau debit dan pelebaran pembuluh darah difus konjungtiva. Discharge dapat menyebabkan mata kerak semalam. Cairan kental dapat mengaburkan penglihatan, tetapi setelah debit akan dihapus, ketajaman visual harus terpengaruh. Gatal dan mendominasi debit berair di konjungtivitis alergi. Chemosis dan hiperplasia papillary juga menyarankan konjungtivitis alergi. Iritasi atau sensasi benda asing, fotofobia, dan debit menunjukkan menular konjungtivitis, discharge purulen menunjukkan penyebab bakteri. Sakit mata yang parah menunjukkan scleritis (lihat Gangguan konjungtiva dan scleral: Scleritis ).

Diagnosa

Klinis Evaluasi Kadang-kadang budaya

Biasanya, diagnosis dibuat berdasarkan riwayat dan pemeriksaan (lihat juga Tabel 1: Gangguan
konjungtiva dan scleral: Fitur Membedakan di Konjungtivitis Akut

), Biasanya termasuk celah-lampu

pemeriksaan dengan pewarnaan fluorescein kornea dan, jika glaukoma diduga, pengukuran tekanan intraokular.

Gangguan lain bisa menyebabkan mata merah (lihat Gejala Gangguan Ophthalmologic: Red
Eye ). Nyeri Jauh di mata yang terkena ketika cahaya sebuah bersinar di mata terpengaruh

(fotofobia benar) tidak terjadi pada konjungtivitis rumit dan menunjukkan gangguan kornea atau saluran uveal anterior. Hiperemi konjungtiva Circumcorneal (kadang-kadang digambarkan sebagai ciliary siram) disebabkan oleh dilatasi, halus, lurus, kapal yang mendalam yang memancar keluar 1 sampai 3 mm dari limbus, tanpa hiperemi signifikan dari konjungtiva bulbar dan tarsal. Siram ciliary terjadi dengan uveitis, glaukoma akut, dan beberapa jenis keratitis. Penyebab konjungtivitis disarankan oleh temuan klinis. Namun, budaya yang diindikasikan untuk pasien dengan gejala yang parah, immunocompromise, mata rentan (misalnya, setelah transplantasi kornea, di exophthalmos akibat penyakit Graves '), atau terapi awal tidak efektif. Diferensiasi klinis antara konjungtivitis infeksi virus dan bakteri sangat tidak akurat. Namun, sementara kehilangan beberapa kasus konjungtivitis bakteri yang ringan tidak mungkin berbahaya karena infeksi sering sembuh spontan dan antibiotik dapat diresepkan jika gejala terus berlangsung.

Tabel 1

Membedakan Fitur di Konjungtivitis Akut


Etiologi Discharge / Type your Eyelid Edema Node Keterlibatan Gatal

Bakteri Purulen / polimorfonuklear leukosit Virus Jelas / mononuklear sel Alergik Jelas, berlendir, berurat / Eosinofil

Moderat Minimal Moderat sampai parah

Biasanya tidak ada Biasanya Tak satupun

Tak satupun Tak satupun Ringan sampai intens

Pengobatan

Pencegahan penyebaran Pengobatan gejala

Konjungtivitis paling menular sangat menular dan menyebar melalui droplet, fomites, dan tangan-ke-mata inokulasi. Untuk menghindari transmisi infeksi, dokter harus mencuci tangan dengan bersih dan disinfeksi peralatan setelah memeriksa pasien. Pasien harus mencuci tangan dengan bersih setelah menyentuh mata atau sekret hidung, hindari menyentuh mata tidak terinfeksi setelah menyentuh mata yang terinfeksi, hindari berbagi handuk atau bantal, dan hindari berenang di kolam renang. Mata harus dijaga bebas dari debit dan tidak harus ditambal. Anak-anak kecil dengan konjungtivitis harus dijaga pulang dari sekolah untuk menghindari menyebar. Waslap dingin diterapkan pada mata dapat membantu meringankan pembakaran lokal dan gatal. Antimikroba digunakan untuk infeksi tertentu. VIRAL KONJUNGTIVITIS Konjungtivitis virus adalah infeksi yang sangat menular konjungtiva akut biasanya disebabkan

oleh adenovirus. Gejala termasuk iritasi, fotofobia, dan debit air. Diagnosis klinis adalah. Infeksi adalah diri-terbatas, tetapi kasus-kasus yang parah kadang-kadang memerlukan kortikosteroid topikal.

Etiologi
Konjungtivitis dapat menemani dingin dan lainnya infeksi umum virus sistemik (terutama campak, tetapi juga cacar, rubella, dan gondok). Konjungtivitis virus terisolasi biasanya dihasilkan dari adenovirus dan kadang-kadang enterovirus. Epidemi keratoconjunctivitis biasanya hasil dari serotipe adenovirus Ad 5, 8, 11, 13, 19, dan 37. Demam Pharyngoconjunctival biasanya dihasilkan dari serotipe Ad 3, 4, dan 7. Wabah konjungtivitis hemoragik akut, konjungtivitis yang jarang berhubungan dengan infeksi oleh jenis enterovirus 70, telah terjadi di Afrika dan Asia.

Gejala dan Tanda


Setelah masa inkubasi sekitar 5 sampai 12 hari, hiperemia konjungtiva, debit berair, dan iritasi mata biasanya dimulai di satu mata dan menyebar dengan cepat ke yang lain. Folikel dapat hadir pada konjungtiva palpebral. Sebuah kelenjar getah bening preauricular sering membesar dan menyakitkan. Banyak pasien memiliki kontak dengan seseorang dengan konjungtivitis, URI baru-baru ini, atau keduanya.
Konjungtivitis (Viral)

Dalam konjungtivitis adenoviral yang parah, pasien mungkin memiliki fotofobia dan sensasi benda asing. Chemosis mungkin hadir. Pseudomembranes fibrin dan sel inflamasi pada konjungtiva tarsal, radang kornea fokal, atau keduanya mungkin mengaburkan visi. Bahkan setelah konjungtivitis telah diselesaikan, sisa kekeruhan kornea subepitel (multiple, berbentuk koin, 0,5 sampai 1,0 mm) dapat terlihat dengan lampu celah hingga 2 tahun. Kekeruhan kornea sesekali mengakibatkan penurunan penglihatan dan silau signifikan.

Diagnosa

Klinis Evaluasi

Diagnosis konjungtivitis dan diferensiasi antara konjungtivitis bakteri, virus, dan tidak menular biasanya klinis, kultur jaringan khusus yang diperlukan untuk pertumbuhan virus tetapi jarang ditunjukkan. Fitur yang dapat membantu membedakan antara konjungtivitis virus dan bakteri dapat mencakup purulence debit mata, kehadiran limfadenopati preauricular, dan, dalam

keratoconjunctivitis epidemi, chemosis. Pasien dengan fotofobia yang diwarnai dengan fluorescein dan diperiksa dengan lampu celah. Keratoconjunctivitis epidemi dapat menyebabkan pewarnaan kornea belang-belang. Infeksi bakteri sekunder dari konjungtivitis virus langka. Namun, jika ada tanda-tanda menunjukkan konjungtivitis bakteri (misalnya, discharge purulen), pap dari mata dapat diperiksa secara mikroskopis dan dibudidayakan untuk bakteri.

Pengobatan

Langkah-langkah pendukung

Konjungtivitis virus sangat menular, dan tindakan pencegahan transmisi harus diikuti (seperti yang dijelaskan sebelumnya). Anak-anak umumnya harus dijauhkan dari sekolah sampai resolusi. Konjungtivitis virus membatasi diri, berlangsung 1 minggu dalam kasus-kasus ringan sampai hingga 3 minggu pada kasus yang berat. Ini hanya membutuhkan kompres hangat atau dingin untuk mengurangi gejala-gejala. Namun, pasien yang memiliki fotofobia berat atau yang memiliki visi dipengaruhi dapat mengambil manfaat dari kortikosteroid topikal (misalnya, 1%prednisolon ORAPRED PRELONE
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asetat q 6 sampai 8 jam). Kortikosteroid, jika diresepkan, biasanya diresepkan oleh dokter mata. Herpes simpleks keratitis (lihat Gangguan Kornea: Keratitis Herpes Simplex ) harus dikesampingkan terlebih dahulu (dengan pewarnaan fluorescein dan celah-lampu pemeriksaan) karena kortikosteroid dapat memperburuk itu. AKUT BAKTERI KONJUNGTIVITIS Konjungtivitis akut dapat disebabkan oleh berbagai jenis bakteri. Gejala hiperemia, lakrimasi, iritasi, dan debit. Diagnosis klinis adalah. Pengobatan dengan antibiotik topikal, ditambah dengan antibiotik sistemik dalam kasus-kasus yang lebih serius. Konjungtivitis bakteri yang paling akut, konjungtivitis bakteri kronis dapat disebabkan olehChlamydia dan jarang Moraxella. Konjungtivitis klamidia termasuk trachoma dan konjungtivitis inklusi dewasa atau neonatal.

Etiologi
Konjungtivitis bakteri biasanya disebabkan oleh Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus sp, atau, kurang umum, Chlamydia trachomatis (lihat Gangguan
konjungtiva dan scleral: Konjungtivitis Inklusi Adult ). Neisseria gonorrhoeae menyebabkan

konjungtivitis gonokokal, yang biasanya dihasilkan dari kontak seksual dengan seseorang yang

memiliki infeksi genital. Ophthalmia neonatorum (lihat juga Infeksi pada Neonatus: Konjungtivitis Neonatal ) adalah konjungtivitis yang terjadi pada 20 sampai 40% dari neonatus disampaikan melalui jalan lahir yang terinfeksi. Hal ini dapat disebabkan oleh gonokokal ibu atau infeksi klamidia.

Gejala dan Tanda


Gejala biasanya unilateral tetapi sering menyebar ke mata berlawanan dalam beberapa hari.Discharge biasanya purulen. The konjungtiva bulbar dan tarsal yang intens hyperemic dan pembengkakan. Perdarahan subconjunctival petechial, chemosis, fotofobia, dan simpul getah bening yang membesar preauricular biasanya absen. Edema kelopak mata sering moderat. Dengan konjungtivitis gonokokal dewasa, gejala berkembang 12 sampai 48 jam setelah paparan. Kelopak mata edema berat, chemosis, dan eksudat purulen berlimpah yang khas.Komplikasi langka termasuk ulserasi kornea, abses, perforasi, panophthalmitis, dan kebutaan.
Konjungtivitis (gonokokus)

Ophthalmia Neonatorum

Ophthalmia neonatorum disebabkan oleh infeksi gonokokal muncul 2 sampai 5 hari setelah melahirkan. Dengan neonatorum Oftalmia disebabkan oleh infeksi klamidia, gejala muncul dalam waktu 5 sampai 14 hari. Gejala keduanya bilateral, konjungtivitis papiler intens dengan edema tutup, chemosis, dan debit mukopurulen.

Diagnosa

Klinis Evaluasi

Diagnosis konjungtivitis dan diferensiasi antara konjungtivitis bakteri, virus, dan tidak menular biasanya klinis. Smear dan budaya bakteri harus dilakukan pada pasien dengan gejala berat, immunocompromise, terapi awal tidak efektif, atau mata rentan (misalnya, setelah transplantasi kornea, di exophthalmos akibat penyakit Graves '). Noda dan mengorek konjungtiva harus

diperiksa secara mikroskopis dan diwarnai dengan pewarnaan Gram untuk mengidentifikasi bakteri dan diwarnai dengan Giemsa noda untuk mengidentifikasi karakteristik sel epitel badan inklusi basofilik sitoplasma konjungtivitis klamidia.

Pengobatan

Antibiotik (topikal untuk semua penyebab kecuali gonokokal)

Konjungtivitis bakteri sangat menular, dan langkah-langkah pengendalian infeksi standar (lihatGangguan konjungtiva dan scleral: Pengobatan ) harus diikuti. Jika tidak infeksi gonokokus atau klamidia diduga, kebanyakan dokter mengobati berdasarkan dugaan dengan moksifloksasin Avelox
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0,5% tetes tid selama 7 sampai 10 hari atau lain fluorokuinolon atau trimetoprim PROLOPRIM TRIMPEX
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/ polimiksin B POLY-RX
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qid. Sebuah respon klinis yang buruk setelah 2 atau 3 hari menunjukkan bahwa penyebabnya adalah bakteri resisten, virus, atau alergi. Kultur dan sensitivitas studi menentukan pengobatan selanjutnya. Adult gonokokal konjungtivitis memerlukan dosis tunggal ceftriaxone Rocephin
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1 g IM. Fluoroquinolones tidak lagi dianjurkan karena resistensi kini tersebar luas.Bacitracin AK-TRACIN BACIGUENT BACIIM
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500 U / g atau gentamisin Garamycin


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0,3% oftalmik salep ditanamkan ke dalam mata q terkena 2 h dapat digunakan di samping pengobatan sistemik. Pasangan seks juga harus diobati. Karena infeksi genital klamidia sering hadir pada pasien dengan gonore, pasien juga harus menerima dosis tunggalazitromisin

Zithromax
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1 g atau doksisiklin PERIOSTAT VIBRAMYCIN


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100 mg po tawaran untuk 7 hari. Neonatorum Oftalmia dicegah dengan penggunaan rutin obat tetes mata perak nitrat ataueritromisin ERY-TAB Erythrocin
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salep saat lahir. Infeksi yang berkembang meskipun pengobatan ini memerlukan pengobatan sistemik. Untuk infeksi gonokokal, ceftriaxone Rocephin
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25 sampai 50 mg / kg IV atau IM diberikan sekali / hari selama 7 hari. Infeksi klamidia diobati dengan eritromisin ERY-TAB Erythrocin
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12,5 mg / kg po atau IV qid selama 14 hari. Orang tua juga harus diobati. DEWASA INKLUSI KONJUNGTIVITIS (Konjungtivitis klamidia Dewasa, Kolam Renang Konjungtivitis) Konjungtivitis inklusi dewasa disebabkan oleh Chlamydia trachomatis menular seksual.Gejala meliputi hiperemi unilateral kronis dan discharge mukopurulen. Diagnosis klinis adalah. Pengobatan dengan antibiotik sistemik. Konjungtivitis inklusi dewasa disebabkan oleh serotipe Chlamydia trachomatis D melalui K. Dalam kebanyakan kasus, hasil inklusi dewasa konjungtivitis dari kontak seksual dengan orang yang memiliki infeksi genital. Biasanya, pasien telah memiliki pasangan seks baru di mo 2 sebelumnya. Jarang, konjungtivitis inklusi dewasa diperoleh dari terkontaminasi, air kolam renang diklorinasi tidak sempurna.

Gejala dan Tanda

Konjungtivitis inklusi dewasa memiliki masa inkubasi 2 sampai 19 hari. Kebanyakan pasien memiliki debit mukopurulen unilateral. Konjungtiva tarsal seringkali lebih hyperemic dari konjungtiva bulbar. Secara karakteristik, ada respon folikel ditandai tarsal. Kadang-kadang, kekeruhan kornea unggul dan vaskularisasi terjadi. Kelenjar getah bening Preauricular dapat membengkak pada sisi mata terlibat. Seringkali, gejala telah hadir selama beberapa minggu atau bulan dan tidak menanggapi antibiotik topikal.

Diagnosa

Klinis Evaluasi Laboratorium Pengujian

Kronisitas, debit mukopurulen, respon folikel ditandai tarsal, dan kegagalan antibiotik topikal membedakan konjungtivitis inklusi dewasa dari conjunctivitides bakteri lainnya. Pap, budaya bakteri, dan studi klamidia harus dilakukan. Teknik pewarnaan immunofluorescent, PCR, dan budaya khusus digunakan untuk mendeteksi C. trachomatis. Noda dan mengorek konjungtiva harus diperiksa secara mikroskopis dan diwarnai dengan pewarnaan Gram untuk mengidentifikasi bakteri dan diwarnai dengan Giemsa noda untuk mengidentifikasi karakteristik sel epitel badan inklusi basofilik sitoplasma konjungtivitis klamidia.

Pengobatan

Antibiotik

Azitromisin Zithromax
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1 g po sekali saja atau baik doksisiklin PERIOSTAT VIBRAMYCIN


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100 mg po tawaran atau eritromisin ERY-TAB Erythrocin


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500 mg po qid untuk 1 wk menyembuhkan infeksi genital konjungtivitis dan secara bersamaan. Mitra seks juga memerlukan pengobatan. ALERGI KONJUNGTIVITIS (Atopik Konjungtivitis, keratoconjunctivitis atopik, Demam Hay Konjungtivitis, Perennial alergi Konjungtivitis, Konjungtivitis alergi musiman, Vernal keratoconjunctivitis)

Konjungtivitis alergi adalah peradangan akut konjungtiva intermiten, atau kronis biasanya disebabkan oleh alergen udara. Gejala termasuk gatal, lakrimasi, debit, dan hiperemia konjungtiva. Diagnosis klinis adalah. Pengobatan dengan antihistamin topikal dan stabilisator sel mast.

Etiologi
Konjungtivitis alergi disebabkan oleh reaksi hipersensitivitas tipe I untuk antigen tertentu. Konjungtivitis alergi musiman (hay fever konjungtivitis) disebabkan oleh serbuk sari dari udara pohon, rumput, atau gulma. Ini cenderung ke puncak selama musim semi, musim panas akhir, atau awal musim gugur dan menghilang selama musim dingin bulan-sesuai dengan siklus hidup tanaman penyebab. Perennial alergi konjungtivitis (atopik konjungtivitis, keratoconjunctivitis atopik) disebabkan oleh tungau debu, bulu binatang, dan alergen lainnya nonseasonal. Alergen ini, terutama di rumah, cenderung menyebabkan gejala sepanjang tahun. Keratoconjunctivitis Vernal adalah jenis yang lebih parah konjungtivitis alergi kemungkinan besar berasal. Hal ini paling umum di antara laki-laki berusia 5 sampai 20 yang juga memiliki eksim, asma, atau alergi musiman. Konjungtivitis Vernal biasanya muncul kembali setiap musim semi dan reda pada musim gugur dan musim dingin. Banyak anak mengatasi kondisi tersebut dengan awal masa dewasa.

Gejala dan Tanda


Umum: Pasien melaporkan bilateral ringan sampai gatal okular intens, hiperemia konjungtiva, photosensitivity (fotofobia pada kasus yang berat), edema kelopak mata, dan debit berair atau benang. Rhinitis seiring umum. Banyak pasien memiliki penyakit atopik lain, seperti eksim, rinitis alergi, atau asma. Temuan khas termasuk edema konjungtiva dan hiperemia dan pelepasan. Konjungtiva bulbar mungkin tampak tembus, kebiruan, dan menebal. Chemosis dan blepharedema berawa karakteristik dari kelopak mata bawah yang umum. Gatal kronis dapat menyebabkan menggosok kelopak mata kronis, hiperpigmentasi periocular, dan dermatitis. Musiman dan abadi konjungtivitis: papila Baik pada konjungtiva tarsal atas memberikan penampilan beludru. Dalam bentuk yang lebih berat, lebih besar papila konjungtiva tarsal, konjungtiva jaringan parut, neovaskularisasi kornea, dan jaringan parut kornea dengan kehilangan variabel ketajaman visual dapat terjadi.

Konjungtivitis (Vernal)

Vernal keratoconjunctivitis: Biasanya, konjungtiva palpebral dari bagian atas kelopak mata yang terlibat, tapi konjungtiva bulbar kadang-kadang terpengaruh. Dalam bentuk palpebral, persegi, keras, rata, erat dikemas, pink pucat dengan papila batu keabu-abuan yang hadir, terutama di konjungtiva tarsal atas. Konjungtiva tarsal tidak terlibat adalah putih susu.Dalam bentuk (limbal) bulbar, konjungtiva circumcorneal menjadi hipertrofi dan keabu-abuan. Discharge mungkin ulet dan berlendir, mengandung eosinofil banyak. Kadang-kadang, kerugian, kecil dibatasi epitel kornea terjadi, menyebabkan rasa sakit dan fotofobia meningkat. Perubahan kornea lainnya (misalnya, plak pusat) dan deposito limbal putih eosinofil (titik Trantas ') dapat dilihat.

Diagnosa
Diagnosis biasanya klinis. Eosinofil yang hadir dalam mengorek konjungtiva, yang dapat diambil dari konjungtiva tarsal bawah atau atas, namun, pengujian tersebut jarang ditunjukkan.

Pengobatan

Gejala tindakan Topikal antihistamin, vasokonstriktor, NSAID, stabilisator sel mast, atau kombinasi Topikal kortikosteroid atau siklosporin Neoral SANDIMMUNE Klik untuk Monografi Obat untuk kasus bandel

Menghindari alergen yang dikenal dan penggunaan suplemen air mata dapat mengurangi gejala, desensitisasi antigen kadang-kadang membantu. Topikal OTC antihistamin / vasokonstriktor (misalnya, naphazoline / pheniramine) berguna untuk kasus-kasus ringan.Jika obat ini tidak cukup, antihistamin resep topikal (misalnya, olopatadine PATANOL
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, ketotifen ALAWAY ZADITOR


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), NSAID (misalnya, ketorolac TORADOL


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), Atau stabilisator sel mast (misalnya, pemirolast ALAMAST


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, nedokromil Tilade
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, azelastine Astelin OPTIVAR


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) Dapat digunakan secara terpisah atau dalam kombinasi. Topikal kortikosteroid (misalnya,loteprednol ALREX LOTEMAX
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, fluorometholone FLAREX FML FORTE FML


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0,1%, prednisolon ORAPRED PRELONE


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asetat 0,12% sampai 1% tetes tid) dapat berguna dalam kasus bandel. Karena kortikosteroid topikal dapat memperburuk herpes simpleks okular infeksi virus, mungkin menyebabkan ulserasi kornea dan perforasi dan, dengan penggunaan jangka panjang, glaukoma dan katarak mungkin, penggunaannya harus dimulai dan dipantau oleh dokter mata. Topikal siklosporin Neoral SANDIMMUNE
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dapat ditunjukkan ketika kortikosteroid yang diperlukan tetapi tidak dapat digunakan. Konjungtivitis alergi musiman kurang mungkin memerlukan beberapa obat atau kortikosteroid topikal intermiten.

Infeksi Konjungtivitis

Bagi Ini

melihat topik terkait dalam manual ini

Konjungtivitis menular adalah peradangan pada konjungtiva biasanya disebabkan oleh virus atau bakteri.

Bakteri dan virus dapat menginfeksi konjungtiva. Kemerahan, iritasi, robek atau debit, dan sensitivitas terhadap cahaya yang umum. Kebersihan yang baik membantu mencegah infeksi dari menyebar. Tetes mata antibiotik sering diberikan.

Berbagai mikroorganisme dapat menginfeksi konjungtiva. Organisme yang paling umum adalah virus, terutama mereka yang berasal dari kelompok yang dikenal sebagai adenovirus.Infeksi bakteri kurang sering. Kedua virus dan bakteri konjungtivitis cukup menular, mudah berpindah dari satu orang ke orang lain, atau dari mata terinfeksi seseorang dengan mata yang tidak terinfeksi. Infeksi jamur jarang terjadi dan terjadi terutama pada orang yang menggunakan mata kortikosteroid tetes untuk waktu yang lama atau memiliki cedera mata yang melibatkan masalah sayuran. Bayi yang baru lahir sangat rentan terhadap infeksi mata, yang mereka peroleh dari organisme di jalan lahir ibu (neonatal conjunctivitis-lihat Masalah di Bayi: Beberapa Infeksi Bayi ).

Konjungtivitis Inklusi adalah bentuk yang sangat tahan lama dari konjungtivitis yang disebabkan oleh strain tertentu dari bakteri Chlamydia trachomatis. Konjungtivitis inklusi biasanya menyebar melalui kontak dengan cairan vagina dari orang yang memiliki infeksi klamidia genital. Trachoma (lihat Gangguan konjungtiva dan scleral: Trachoma ) adalah jenis lain dari konjungtivitis yang disebabkan oleh Chlamydia trachomatis. Tipe lain dari konjungtivitis yang disebabkan oleh Neisseria gonorrhoeae (gonore), penyakit menular seksual yang juga dapat menyebar ke mata. Infeksi berat mungkin bekas luka konjungtiva, menyebabkan kelainan dalam film air mata.Kadang-kadang, infeksi konjungtiva parah menyebar ke kornea (bagian transparan dari mata).

Gejala
Ketika terinfeksi, mata kadang-kadang terasa ringan jengkel, dan terang dapat menyebabkan ketidaknyamanan. Konjungtiva menjadi merah muda dari pembuluh darah membesar, dan debit muncul di mata. Seringkali debit menyebabkan mata orang tersebut untuk tetap menutup, terutama dalam semalam. Debit ini juga dapat menyebabkan visi untuk kabur. Visi meningkatkan debit saat ini berkedip pergi. Jika kornea terinfeksi, visi juga mengaburkan namun tidak membaik dengan berkedip. Sangat jarang, infeksi berat yang telah terluka memimpin konjungtiva jangka

panjang kesulitan visi.


Konjungtivitis

Konjungtivitis virus berbeda dari konjungtivitis bakteri dengan cara berikut:

Debit mata cenderung berair dalam konjungtivitis virus dan tebal putih atau kuning dalam konjungtivitis bakteri. Infeksi saluran pernapasan atas meningkatkan kemungkinan penyebab virus. Sebuah kelenjar getah bening di depan telinga mungkin bengkak dan sakit di konjungtivitis virus tetapi biasanya tidak dalam konjungtivitis bakteri.

Faktor-faktor ini, bagaimanapun, tidak bisa selalu akurat membedakan konjungtivitis virus dari konjungtivitis bakteri. Orang dengan konjungtivitis inklusi atau dengan konjungtivitis yang disebabkan oleh gonore sering memiliki gejala infeksi genital, seperti debit penis atau vagina dan pembakaran saat buang air kecil.

Diagnosa
Dokter mendiagnosa konjungtivitis menular dengan gejala dan penampilan. Mata biasanya erat diperiksa dengan lampu celah (alat yang memperbesar permukaan mata). Sampel dari sekret yang terinfeksi mungkin dikirim ke laboratorium untuk mengidentifikasi organisme penyebab infeksi oleh budaya. Namun, dokter biasanya melakukan ini hanya jika gejala yang parah atau berulang atau ketika klamidia atau gonore Neisseria diperkirakan menjadi penyebabnya.

Apa mata yg menular?


Meskipun sebagian besar mata radang mengakibatkan perubahan warna pink mata (karena pembuluh darah melebar di konjungtiva), dokter biasanya menggunakan mata yg menular istilah untuk konjungtivitis yang disebabkan oleh infeksi dengan bakteri atau virus. Salah satu bentuk yang paling parah dari penyakit mata yg menular adalah hasil dari infeksi dengan strain tertentu beberapa adenovirus. Ini infeksi,

keratoconjunctivitis epidemi, sangat menular dan sering mengakibatkan wabah besar dalam sebuah komunitas atau sekolah. Infeksi ini menyebar melalui kontak dengan cairan terinfeksi. Kontak mungkin terjadi orangke-orang atau melalui benda yang terkontaminasi, mungkin termasuk instrumen dokter '. Gejala infeksi ini mirip dengan jenis lain dari debit virus konjungtivitiskemerahan, iritasi, sensitivitas terhadap cahaya, dan tipis, berair. Banyak orang mengembangkan simpul getah bening di depan telinga pada sisi yang terkena. Ini biasanya berlangsung dari 1 hingga 3 minggu gejala.Beberapa orang memiliki pandangan yang kabur, yang bisa berlangsung selama beberapa minggu atau bulan sebelum menyelesaikan. Epidemi keratoconjunctivitis menyelesaikan sepenuhnya tanpa pengobatan khusus. Dokter kadangkadang memberikan tetes kortikosteroid kepada orang-orang dengan visi yang sangat kabur atau sensitivitas terhadap cahaya yang parah.Kebersihan yang baik, mencuci tangan khususnya, diperlukan untuk meminimalkan penyebaran infeksi. Handuk yang terpisah, washcloths, dan bantuan tempat tidur meminimalkan penyebaran ke anggota lain dari rumah tangga. Orang biasanya tinggal di rumah dari kerja atau sekolah selama beberapa hari atau, dalam kasus yang parah, bahkan berminggu-minggu.

Prognosis dan Pengobatan


Kebanyakan orang dengan konjungtivitis menular akhirnya sembuh tanpa pengobatan.Namun,

beberapa infeksi, terutama yang disebabkan oleh beberapa bakteri, dapat bertahan lama jika tidak diobati. Konjungtivitis Inklusi dapat bertahan selama berbulan-bulan jika tidak diobati. Jika debit terakumulasi pada kelopak mata, orang harus hati-hati mencuci kelopak mata (dengan mata tertutup) dengan air keran dan kain lap bersih. Kompres hangat atau dingin kadangkadang menenangkan perasaan iritasi.Karena infeksi (bakteri atau virus) konjungtivitis sangat menular, orang harus mencuci tangan mereka sebelum dan setelah membersihkan mata atau menerapkan obat. Juga, seseorang harus berhati-hati untuk tidak menyentuh mata yang terinfeksi dan kemudian menyentuh mata lainnya. Handuk dan washcloths digunakan untuk membersihkan mata harus disimpan terpisah dari handuk dan washcloths lainnya.Orang dengan konjungtivitis infeksi umumnya tinggal pulang dari kerja atau sekolah selama beberapa hari, seperti mereka akan dengan dingin. Dalam kasus yang paling parah dari konjungtivitis virus, orang kadang-kadang tinggal di rumah selama berminggu-minggu. Antibiotik membantu hanya dalam konjungtivitis bakteri. Namun, karena sulit untuk membedakan antara infeksi bakteri dan virus, dokter kadang-kadang meresepkan antibiotik untuk semua orang dengan konjungtivitis.Antibiotik tetes mata atau salep, seperti siprofloksasin CILOXAN Sipro atau trimetoprim-polimiksin , Yang efektif terhadap berbagai jenis bakteri, yang digunakan selama 7 sampai 10 hari.Drops diterapkan 4 kali sehari. Salep bertahan lebih lama dan diterapkan setiap 6 jam tapi visi blur. Konjungtivitis Inklusi memerlukan antibiotik, seperti azitromisin Zithromax , doxycycline VIBRAMYCIN , Atau eritromisin E-MYCIN Erythrocin , Yang diambil melalui mulut. Gonokokal konjungtivitis dapat diobati dengan suntikanceftriaxone Rocephin . Tetes mata kortikosteroid mungkin diperlukan pada beberapa orang dengan konjungtivitis adenoviral parah, terutama pada mereka yang dalam peradangan mata yang mengganggu kegiatan sehari-hari yang penting. Tetes Antiviral tidak membantu untuk konjungtivitis kebanyakan disebabkan oleh virus, dengan beberapa pengecualian. Sebagai contoh, seseorang dengan konjungtivitis virus yang disebabkan oleh herpes mungkin berlaku obat antivirus untuk mata ( trifluridine VIROPTIC tetes mata) atau membawa mereka melalui mulut ( asiklovir

Zovirax ).